New England Journal of Medicine
December 18, 2014 Vol. 371 No. 25
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Panic, Paranoia, and Public Health — The AIDS Epidemic’s Lessons for Ebola
Gregg Gonsalves, B.S., and Peter Staley
N Engl J Med 2014; 371:2348-2349 December 18, 2014
DOI: 10.1056/NEJMp1413425
For those of us who lived through the early days of the U.S. AIDS epidemic, the current national panic over Ebola brings back some very bad memories. The toxic mix of scientific ignorance and paranoia on display in the reaction to the return of health care workers from the front lines of the fight against Ebola in West Africa, the amplification of these reactions by politicians and the media, and the fear-driven suspicion and shunning of whole classes of people are all reminiscent of the response to the emergence of AIDS in the 1980s…

Perspective
Evaluating Ebola Therapies — The Case for RCTs
Edward Cox, M.D., M.P.H., Luciana Borio, M.D., and Robert Temple, M.D.
N Engl J Med 2014; 371:2350-2351 December 18, 2014
DOI: 10.1056/NEJMp1414145

Brief Report
Clinical Care of Two Patients with Ebola Virus Disease in the United States
G. Marshall Lyon, M.D., M.M.Sc., Aneesh K. Mehta, M.D., Jay B. Varkey, M.D., Kent Brantly, M.D., Lance Plyler, M.D., Anita K. McElroy, M.D., Ph.D., Colleen S. Kraft, M.D., Jonathan S. Towner, Ph.D., Christina Spiropoulou, Ph.D., Ute Ströher, Ph.D., Timothy M. Uyeki, M.D., M.P.H., M.P.P., and Bruce S. Ribner, M.D., M.P.H. for the Emory Serious Communicable Diseases Unit
N Engl J Med 2014; 371:2402-2409
December 18, 2014
DOI: 10.1056/NEJMoa1409838
Abstract
West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients’ condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma.

Editorial
Out of Africa — Caring for Patients with Ebola
Eric J. Rubin, M.D., Ph.D., and Lindsey R. Baden, M.D.
N Engl J Med 2014; 371:2430-2432 December 18, 2014
DOI: 10.1056/NEJMe1412744
[Final paragraph]
…The most important take-home message from these case reports is the importance of intensive fluid management and care. The case fatality rate in the current outbreak is approximately 70%.8 It is unlikely that the patient treated in Germany would have survived without modern, state-of-the-art care. But approximately 30% of patients are surviving with only the modest support that is available in treatment centers in West Africa. Another filovirus infection, Marburg hemorrhagic fever, was associated with a mortality rate of approximately 25% in Germany but approximately 80% in sub-Saharan Africa, further suggesting that optimal supportive care plays a crucial role in the overall outcome of these infections.9,10 Although this news is encouraging for patients with access to an intensive care unit, it is only more discouraging for those in areas where such infections are endemic and even basic care is often unavailable. It will be a tremendous challenge to bring to all patients the benefits of routine care, such as intravenous fluid and electrolyte support, as part of the response to this epidemic, but it must be done.